Director of the Adelphi University Center for Health Innovation; primary investigator for the project

Native
Americans develop diabetes at a rate of 33%--three times greater than Whites
and twice that of African Americans. People of all races living with diabetes
experience are two to four times greater risk of developing stroke,
hypertension, kidney disease, dental and periodontal disease, and blindness.
Recently, the members of the Unkechaug Nation have become increasingly
concerned about the exponentially rising rate of diabetes on their reservation,
as the numbers reflect the national trends. But a window of opportunity exists when
lifestyle modifications can stop or significantly delay the progression of
disease from pre-diabetes to diabetes type 2. These changes in diet and
exercise are best initiated at the community–level, tailored so that they meet
the needs of those who are using them.

To
understand how to modify an existing set of evidence-based recommendations from
the Centers for Disease Control and Prevention, a three-way collaboration has
been developed between the Unkechaug Nation, Adelphi University Center for
Health Innovation and Winthrop-University Hospital Diabetes and Obesity Institute.
The Unkechaug Nation’s Initiative to End Diabetes
(UNITED) collaborative proposes to:

(1)
outline a set of partnership steps for a community-based effort focused on
education and lifestyle modification

(2)
explore and design infrastructure for community-engaged research on the
reservation

(3)
develop a governance structure that would support applications for future
funding opportunities

(4)
formulate metrics for a measurable outreach plan

(5)
develop a guide for other reservations who wish to adapt pre-diabetes and
diabetes prevention programs.

Co-investigator
of the project is Harry B. Wallace, the chief of the Unkechaug Nation. Virginia
Peragallo-Dittko, executive director of the Diabetes and Obesity
Institute at Winthrop-University Hospital in Mineola to serve as a consultant.

Monday, April 27, 2015

Running a hospital well or badly has life or death
consequences. Wei Liu, Ph.D., and Susan Zori, D.N.P., know this all too well
from their long experiences as hospital nurses and their more recent pursuits
as academic researchers.

Prior to joining the Adelphi faculty as an assistant
professor in the College of Nursing and Public Health, Dr. Liu worked for more
than a decade as an emergency room nurse in China and Australia. Dr. Liu became
fascinated by the complexities of how nurses, doctors and pharmacists
communicate across their various disciplines in order to dispense medications.

What does it mean, for example, that doctors make medication
decisions at the central staff station, away from patients’ bedsides? Or that
they make their medical ward rounds when nurses are absent? What is the impact
on patient care when doctors, nurses and pharmacists conduct separate staff
meetings?

Through interviews with and observations of doctors,
pharmacists, nurses and patients, Dr. Liu documented patterns of communication
and miscommunication in medication management at a major metropolitan hospital
in Melbourne, Australia.

As a nurse in a separate ward at the hospital, Dr. Liu was
able to establish credibility and rapport with the professionals and patients
she was studying, to the point that they allowed her to videotape their
clinical interactions.

Dr. Liu’s ultimate goal was to improve patient safety at the
hospital. In addition to publishing papers based on her research, she took her
findings back to the hospital professionals. In focus groups, she shared her
data and a DVD she produced and encouraged discussion. Her aim, she said, was
to “have them look at their own practices to see where the communication gaps
might be and how we could improve our interdisciplinary communication and then
improve our patient safety.”

Dr. Zori, a clinical assistant professor at Adelphi’s
College of Nursing and Public Health, has practiced nursing for 40 years, many
of them as a nursing director at prominent hospitals in New York City and on
Long Island. During decades of overseeing teams of nurses, she grew curious about
why some teams exuded positive energy and excelled while others seemed
disgruntled and performed less well. She suspected that the nurse managers’
critical thinking abilities and attitudes played a significant role.

In an often-cited study of nurse managers and their staffs,
Dr. Zori and her colleagues validated this hunch. Nurse managers who scored
high in seven categories of critical thinking disposition, ranging from
open-mindedness and inquisitiveness to truth seeking and cognitive maturity,
had staffs who felt better about their work and, as a result, were more likely
to provide safer and more effective patient care.

Dr. Zori has since been testing ways to boost the critical
thinking skills of up-and-coming nurses. Working with administrators at North
Shore LIJ Health System’s Center for Learning and Innovation, for example, she
created a critical thinking class for nurses in the system’s fellowship
program. From journals that the nurses kept, Dr. Zori observed that many had
become more attuned to the importance of being inquisitive and analytical in
their work.

In her classes at Adelphi, Dr. Zori encourages critical
thinking by emphasizing case studies and interaction. “For me, it’s constantly
challenging myself to find a way to get [students] to critically think and to
be creative and interactive so that they’re not just learning information,
they’re applying it to real-life situations,” she said.

Monday, April 20, 2015

When
the Center for Health Innovation (CHI) announced its Summer Scholar Program in
2014, I jumped at the opportunity to apply. CHI made it possible
for AU faculty to enroll in a variety of summer skill building courses and
seminars offered at the Mailman School of Public Health at Columbia
University. Since I had been working on
a project on Mexican migration, I was particularly interested in the Social
Network Analysis (SNA) course. I had conducted in-depth interviews with
migrants from Tlaxcala, Mexico with funding from the Russell Sage Foundation
and was interested in finding out if network analysis would enrich my study. Based
on preliminary analysis of these interviews, the data revealed that
relationships between migrants were meaningful structures. That is, I was
finding that social ties are how migrants find housing, jobs, and information
about community resources. And equally as important, the formalized structures
of these relationships seemed to be the basis for inclusion and exclusion when
forming community. Given my interests in social relationships, I was delighted
when I found out that I would indeed be able to enroll in the SNA course.

The course I participated in provided
an excellent introduction to the conceptual and computational principles of
SNA. On our first day, we covered what Social
Network Analysis is and is not, what counts as network data, and how to collect
it. We spent time using R, a language
and platform for statistical computing and graphing in order to manipulate
network matrices and visualize network data.Thereafter, we quickly moved on to a discussion of ego-networks and the
meaning of distance, density, and balance within an individual’s networks.By day three, we covered higher-order network
structures: the group and entire networks. All the while, we focused on
important network structural features such as equivalence, clustering,
centrality, and cohesion. For example,
in a migrant network computing centrality indices might tell us which
individual in a network is the most central or popular.

The fourth day of the course was by
the best part – we put our knowledge to work by focusing on applications of
SNA. We explored examples from
epidemiological research such as the transmission of AIDS, the structure of
adolescent romantic and sexual networks, and the dynamics of smoking in large
networks. Each of these empirically
motivated problems gave us a glimpse into how network analysis is applied. More specifically, we focused on three network
processes: Search, Diffusion, and Influence.And, we replicated analyses of classic studies that examine how network ties
facilitate the exchange of employment information as well as the efficiency of
job search strategies in networks.

On
the final day of the course, we covered statistical models and worked through
tutorials in R. The instructor
introduced network autocorrelation and stochastic actor oriented (SIENA)
models.Since I had experience with spatial analytic techniques, the
network autocorrelation model was familiar. In a recently published paper, I
used neighborhood-level data to estimate spatial lag models that follow similar
autocorrelation properties.

After completing the course, I have
spent much time thinking more about how I might use the insights of network
analysis to ask, what network practices in the small migrant community I have
been studying might tell us something about the raising and blurring ethnic boundaries?
My hope is that by integrating social network analysis into my research I will
make new inroads into the ways in which migrant communities come to make sense
of the places they live and work in.

For too many people with mental illness, crisis medical
care has become the norm—a trend that has a great personal and financial toll. In
2013, hospitalizations for Nassau County residents who received Medicaid mental
health services cost the agency more than $35 million. The fact that many
patients are rehospitalized within 30 days of discharge calls into question the
effectiveness of this crisis approach to mental healthcare.

To address
this issue, New York State is now working with physicians and health clinics to
provide health homes for Medicaid recipients who suffer from chronic mental and
physical illness. The health home concept is to offer an integrated system of
care in which a patient’s needs—from scheduling medical appointments to
providing transportation to those appointments to setting up social
services—are coordinated by a small interdisciplinary team or an individual
care manager.

Central
Nassau Guidance & Counseling Services, Inc., based in Hicksville, New York,
is one agency that offers health home services. Last year, with funds from a
New York State Innovation Fund grant, the agency established its Stability at
Home pilot program to help Medicaid recipients with serious mental health
conditions transition from hospitalization or haphazard community care into a
more stable health home system of care.

Chrisann
Newransky, Ph.D., an assistant professor at Adelphi’s School of Social Work,
explained that a primary goal of this new approach is to facilitate the many healthcare
responsibilities and tasks that seem routine to the rest of us. “If people stay
connected to the system—they don’t drop out of the system—then they’re less
likely in general to use emergency care, which we know is completely expensive
and not all [that] effective,” she said.

After
consulting with Adelphi’s Center for Nonprofit Leadership and its faculty
director, Peter Chernack, Ph.D., Central Nassau Guidance & Counseling
tapped Dr. Newransky, whose primary research interests are disease prevention
and health disparities, to be the external evaluator of Stability at Home.

Dr.
Newransky is advising on the best sources of data and approaches to data
collection for evaluating the program’s effectiveness for the nearly 150
participants and their families. She is also conducting independent follow-up
research with the participants and families.

“What’s unique
about the [program] design is that different organizations are coming
together,” she said, noting that the Long Island Crisis Center and Options for
Community Living, Inc. are also involved in the project. This coming summer,
Dr. Newransky plans to interview the leaders of the three organizations in
order to document this model of interagency collaboration and understand what
worked well and what improvements can be made.

Monday, April 13, 2015

What is the relationship between early-life trauma and
addiction? What treatments are most effective for people, particularly poor
women and families who are struggling with these often-linked challenges? How
can these treatments be implemented in community clinics?

These are questions that Denise Hien, Ph.D., a professor at
the Gordon F. Derner Institute of Advanced Psychological Studies, has been
seeking to answer throughout her career. A researcher, clinician and teacher,
her overarching aim is to “understand how early-childhood abuse evolves over
the course of life and intersects with substance use and other kinds of
problems.”

Dr. Hien has noted that “as many as 80 percent of women
seeking treatment for drug abuse report lifetime histories of sexual and/or
physical assault.” Through her clinical work with women and families in New
York City’s Harlem, Morningside Heights and Washington Heights neighborhoods,
as well as her national research, Dr. Hien works to improve treatment outcomes
for patients who struggle with trauma and substance abuse.

Since 2002, Dr. Hien has been a co-principal investigator
with the National Institute on Drug Abuse (NIDA) Clinical Trials Network
Greater New York Node. The network is a federal initiative to link researchers
and community-based treatment centers to allow real-world studies of drug
treatments. In a recent NIDA-sponsored study, for example, Dr. Hien and her
team examined what happened when an antidepressant medication was added to a cognitive
behavioral therapy treatment for PTSD and alcohol use disorders. The
researchers found that the drug combined with the therapy, known as Seeking
Safety, was significantly more effective at treating PTSD and alcohol abuse
than therapy alone.

“You might think, ‘Well isn’t that obvious? That’s what
people do, they give [patients] medication and they give them therapy,” Dr. Hien
said. “But nobody really knows if it works. So here’s a trial that showed that
it really works.”

In another NIDA-sponsored project, Dr. Hien and her colleagues
worked with drug counselors across the country to see if they could safely and
effectively conduct trauma treatment groups with their clients. “The answer was
yes they could, so it provided support for being able to translate treatment
into the real world,” Dr. Hien said.

Having conducted numerous clinical trials, Dr. Hien is
intimately familiar with their advantages as well as their shortcomings. “It’s
hard to show big effects with relatively small sample sizes,” she pointed out,
adding, “And then there’s the problem of ending up testing what amount to short-term
treatments for long-term problems.”

How can these challenges be overcome? For Dr. Hien, the
short answer is big data. She is now applying for a grant to create a large data
set from more than 20 clinical trials that tested the efficacy of medication
and psychotherapy in treating PTSD and substance use disorders. Dr. Hien
explained that with information on thousands of patients, “you can ask
questions that are more nuanced when it comes to trying to advance the science
of treatment.”

Dr. Hien teaches master’s- and doctorate-level psychology
courses at Adelphi and says that her work in the field amplifies what she can
offer students in the classroom.

“My clinical work and my research inform my teaching because
they’re what I’m passionate about, and usually I’m teaching things that link up
to these topics,” she said.

Monday, April 6, 2015

On Monday, March 30 Adelphi University’s Center for
Health Innovation and Winthrop University Hospital hosted a Sports Concussion
Symposium, a rapid response event designed to react to emergent health issues
on Long Island. The event featured a variety of speakers and panelists,
providing an overview of concussions and the importance of recognizing its
symptoms.

Concussions are defined as a trauma-induced alteration
in a person’s mental state, with physical, cognitive, emotional, or
sleep-related symptoms. While higher-grade concussions tend to involve a loss
of consciousness, not every concussion does. A single concussion can take
weeks, months, or even years to heal completely.

“Every concussion is different,” said Dr. Kevin
Curley, an attending physician at Winthrop University Hospital. “Each
concussion can have varying combinations of symptoms.”

Multiple concussions can lead to detrimental
long-term health problems, such as chronic traumatic encephalopathy (CTE) and
traumatic brain injury. A concussion occurring before a previous one has
completely healed can lead to second impact syndrome, a fatal brain herniation.

Among the panelists was Pat LaFontaine, National
Hockey League Hall of Fame member, who attested to the severity of concussion
symptoms. “All those symptoms are for real,” LaFontaine said. “I was lucky my
brain found its way back and plugged itself back in.”

Several states, including New York, have legislated
the return-to-play criteria for concussed athletes, which often prohibit students
from playing on the same day as their head injury. Even the international
community has created guidelines for a standardized concussion assessment.

Baseline testing for athletes in balance, cognition,
and emotion is extremely important. After a hit to the head, the same tests can
be conducted to more easily diagnose a concussion. Coaches, parents, and
teachers are also crucial to concussion diagnosis, as they are most familiar
with student athletes and may be able to more easily identify changes in
behavior than a physician.

“Sports provide many positive benefits to our
children and young adults,” said Don Gronachan, vice president of physical
medicine sales at Biodex Medical Systems, Inc. “But we are concerned about the
short- and long-term safety of these young athletes.”

The CHI Rapid Response: Sports Concussion Symposium consisted
of Emilia Zarco, Robert Otto, John Wygand, and John Petrizzo in the Ruth S.
Ammon School of Education, Department of Exercise Science, Health Studies, Physical
Education and Sport Management; and Daniel McCabe and Michael Gavagan in the Department
of Athletics.